Teeth penetration force of the tiger shark Galeocerdo cuvier and sandbar shark Carcharhinus plumbeus.

This study examined the minimum force required of functional teeth and replacement teeth in the tiger shark Galeocerdo cuvier and the sandbar shark Carcharhinus plumbeus to penetrate the scales and muscle of sheepshead Archosargus probatocephalus and pigfish Orthopristis chrysoptera. Penetration force ranged from 7·7-41·9 and 3·2-26·3 N to penetrate A. probatocephalus and O. chrysoptera, respectively. Replacement teeth required significantly less force to penetrate O. chrysoptera for both shark species, most probably due to microscopic wear of the tooth surfaces supporting the theory shark teeth are replaced regularly to ensure sharp teeth that are efficient for prey capture.

Report from the third international consensus meeting to harmonise core outcome measures for atopic eczema/dermatitis clinical trials (HOME).

This report provides a summary of the third meeting of the Harmonising Outcome Measures for Eczema (HOME) initiative held in San Diego, CA, U.S.A., 6-7 April 2013 (HOME III). The meeting addressed the four domains that had previously been agreed should be measured in every eczema clinical trial: clinical signs, patient-reported symptoms, long-term control and quality of life. Formal presentations and nominal group techniques were used at this working meeting, attended by 56 voting participants (31 of whom were dermatologists). Significant progress was made on the domain of clinical signs. Without reference to any named scales, it was agreed that the intensity and extent of erythema, excoriation, oedema/papulation and lichenification should be included in the core outcome measure for the scale to have content validity. The group then discussed a systematic review of all scales measuring the clinical signs of eczema and their measurement properties, followed by a consensus vote on which scale to recommend for inclusion in the core outcome set. Research into the remaining three domains was presented, followed by discussions. The symptoms group and quality of life groups need to systematically identify all available tools and rate the quality of the tools. A definition of long-term control is needed before progress can be made towards recommending a core outcome measure.

Trying to keep ahead of lice: a therapeutic challenge.

Pediculosis capitis, or head lice, is a world-wide public health concern affecting persons of all ages and socioeconomic backgrounds. It is caused by Pediculus humanus capitis, an obligate ectoparasite that lives on human hair and feeds on the blood from the skin. Upon diagnosis, treatment should be initiated, since established infestations with head lice generally do not spontaneously resolve. Chemical pediculicides are currently the standard treatment, however, issues of resistance have made it necessary to explore new alternatives. If an infestation is resistant to these drugs, then the physician should consider treating with an agent from a different class of pediculicides or, potentially, with newer nonpediculicides.

Practical management strategies for diaper dermatitis.

Common diaper dermatitis is an irritant contact diaper dermatitis (IDD) created by the combined influence of moisture, warmth, urine, feces, friction, and secondary infection. It is difficult to completely eradicate these predisposing factors in a diapered child. Thus, IDD presents an ongoing therapeutic challenge for parents, family physicians, pediatricians, and dermatologists. This article will focus on practical management strategies for IDD.

Disseminated linear calcinosis cutis associated with the Koebner phenomenon in an infant with congenital acute monocytic leukaemia.

We present a unique case of an infant with acute monocytic leukaemia who presented at birth with multiple rubbery, erythematous to violaceous subcutaneous nodules secondary to leukaemia cutis. As these infiltrates regressed with chemotherapy, numerous white to yellow linear confluent papules appeared in a scratch-like pattern. These lesions were widely disseminated but were concentrated across her face, trunk and extremities with relative sparing of the napkin area and back. We propose that these lesions represent a form of dystrophic calcinosis cutis that occurred secondary to koebnerization in an infant with congenital leukaemia cutis.

Pimecrolimus 1% cream (Elidel) for atopic dermatitis.

Pimecrolimus is an immunomodulating medication that inhibits production of inflammatory cytokines in the skin and this compound was specifically developed for the treatment of inflammatory skin diseases. Phase II and III clinical trials with the topical formulation of pimecrolimus (Elidel cream, Novartis) have shown that it is safe and effective for use in patients with atopic dermatitis (AD). The US FDA recently approved Elidel for use in patients >or=2 years of age and older with mild to moderate atopic dermatitis (AD).

Crusted scabies in association with human T-cell lymphotropic virus 1.

BACKGROUND: Human T-cell lymphotropic virus I (HTLV- 1) infection can lead to myelopathy/tropical spastic paresis and adult T-cell leukemia/lymphoma (ATLL). Infection with HTLV-1 has also been associated with clinically significant immunosuppression. Crusted scabies, also known as Norwegian scabies, is an uncommon presentation of scabies that may occur in conjunction with immunosuppression. Although crusted scabies has been reported in association with HTLV-1 infection, to our knowledge it has never been described in association with HTLV-1 associated myelopathy. OBJECTIVE: The aim is to describe a case of HTLV-1 associated myelopathy and concomitant crusted scabies. METHODS: This article includes a case report and a literature review. CONCLUSIONS: Crusted scabies is reported in association with HTLV-1 infection with or without concomitant ATLL. Crusted scabies should be considered in the differential diagnosis of a generalized cutaneous eruption in an HTLV-1 positive patient. Patients with crusted scabies from an HTLV-1 endemic population should be rested for a possible HTLV-1 infection. These patients may be at increased risk of progressing to ATLL.

Problem solving, stress, and coping in adolescent suicide attempts.

Twenty adolescents who had made suicide attempts were compared with 20 nonpsychiatric control subjects on measures of problem solving, stress, and coping. The suicidal group did not show evidence of "rigid" thinking or of deficits in the ability to generate solutions to standardized interpersonal problems. However, they did report recent histories of more severe life stress and had inaccurate appraisal of the extent to which stressful events could be controlled. Although suicidal patients were able to generate as many adaptive strategies as control subjects for coping with their own most severe recent real-life stressor, they actually used fewer. They were also more likely to identify maladaptive behaviors as ways of coping. These findings support a transactional model of adolescent suicidal behavior, whereby inaccuracies in the appraisal aspects of problem solving (but not in the solution-generation aspects) in the face of high life stress lead to a reduction in the use of adaptive efforts to cope.

Electroconvulsive therapy in the treatment of depression: the impact on length of stay.

It has been reported that one advantage to administering electroconvulsive therapy (ECT) for the treatment of depression is that it results in shorter hospitalizations than alternative treatments. The generality of this finding was assessed in the present study, which comprised a retrospective review of 192 admissions for depression. It was found that the prompt initial decision to administer ECT did not reduce the overall length of hospital stays. In fact, patients who were discharged after an initial medication trial actually had shorter admissions than patients treated promptly with ECT. Nevertheless, one subgroup of patients--those who were started on medications, but who were later switched to ECT--had very long admissions. Whether the prompt initiation of ECT will reduce the average length of stay at any individual institution may depend on the numbers of patients who fall into this latter category. This number, in turn, appears to vary widely across institutions.